Mental health care utilization following a new positive PTSD screen in primary care in the Veterans Health Administration

Abstract: Although there is an active screening program for posttraumatic stress disorder (PTSD) in Veterans Health Administration (VHA) primary care clinics and empirically supported treatments for PTSD are available, many patients who are identified through screening and receive a new PTSD diagnosis do not engage in cognitive processing therapy (CPT) or prolonged exposure therapy (PE). CPT and PE are both widely promoted and recommended first-line treatments in the VHA that were the focus of the VHA's initial implementation of evidence-based psychotherapy for PTSD. We examined the mental health care patients received following a new positive PTSD screen in VHA primary care clinics and whether health system factors were associated with engaging in CPT or PE. A national cohort of VHA primary care patients who screened positive for PTSD in 2018 were followed for 1 year from the date of screening. Overall, 20,853 patients screened positive for PTSD; of these, 76% received a diagnostic clinical evaluation, and 86% of these patients evaluated received a confirmatory PTSD diagnosis within 1 year of screening. Ten percent (n = 1,372) of patients who received a confirmatory PTSD diagnosis engaged in CPT or PE. Confirmatory evaluation location (in a PTSD specialty clinic) and timing (within 3 months of screening) were each associated with increased likelihood of engaging in CPT or PE. Most patients who screen positive for PTSD in VHA primary care clinics are connected to follow-up clinical evaluations and receive confirmatory PTSD diagnoses. However, only one-in-ten patients who screen positive and receive a confirmatory PTSD diagnosis go on to receive CPT or PE. Screening appears to more effectively lead to patients with PTSD engaging in CPT or PE when the confirmatory evaluation occurs quickly and in a setting prepared to deliver evidence-based treatment.